Why Don’t Addiction Rates Ever Seem to Fall?

Stanton Peele, PhD, JD, co-author of Love and Addiction and Recover! Stop Thinking Like an Addict with The PERFECT Program, is well-known for his controversial views of addiction – namely, that addiction is not a disease and that treatment is not necessary to overcome addiction. Here, Dr. Peele gives his in-depth answer to a complex and much-debated question: Why do rates of addiction and alcoholism never seem to decline in spite of more research, more money, more awareness, more time and more options for treatment?

“After we passed the Harrison Act in 1914 — so a hundred years after we made narcotics illegal — we’re now having yet another surge and epidemic with heroin and we also have to throw into the mix alcohol. How is it that we never see a decline in drinking problems or alcoholism? If you go to any addiction expert, nobody will say alcoholism is declining in America. Nobody. That creates a paradox. If our current method of dealing with alcoholism – AA and the 12 steps – is so effective, if so many people swear by them, if virtually all treatment centers use them, then] why don’t we ever see a decline in drinking problems? A recent national survey by the National Institute of Alcohol Abuse and Alcoholism found a 50% increase in past-year alcohol use disorders over the last decade.

The quickest answer that people usually give is, ‘Well, not enough people are taking advantage of or swearing allegiance to the 12 steps.’ Really? In America, AA is pretty well-known: Every advice columnist in the country will tell you about it; leading magazines are always talking about it; big stars have always just come into or out of AA or a 12-step program. The question then becomes, if not enough people are swearing allegiance to AA after 80 years, why is that? Why isn’t it having the effect we want?

Is the Neuroscientific Approach Useful?

“On top of that, we have this neuroscientific revolution where everybody is on the edge of their seats expecting they’re going to discover the cure for addiction or the source for addiction in the brain momentarily. We’re building all kinds of new drugs that are supposedly effective for dealing with drug addiction and alcoholism. So we’ve got the old way of dealing with it [i.e., AA], which really everybody still swears allegiance to, and a new medical way of dealing with it. And, yet this neuroscientific revolution has been around now for 40 years.

The first major neuroscientific discovery around addiction was made around 1976 with the endorphins, naturally-occurring opiate peptides in the brain. From the very beginning of this discovery, you would read, ‘we’re going to cure narcotic addiction shortly.’ The main change that has happened is not that we’ve reduced addiction; instead, the main change is that they’re not making immediate promises anymore. Now they’re projecting changes down the road, perhaps a half-century.

I think it’s time to fundamentally question whether we’re pursuing the right track or whether we’re thinking about addiction in the right way. You might say we need to treat more Americans, but a lot more Americans are treated for addiction than in any other country. If you go to the Netherlands, they don’t have recovery high schools like we do. They don’t have recovery dormitories like we do. Other countries haven’t decided that they’re going to turn the whole country over to the recovery movement.

Americans are convinced that we have great approaches for addiction. We love our 12 steps. We have overwhelming belief in the promise of new medical discoveries that are going to cure addiction. Yet if you ask anybody, ‘Do you expect addiction to decline in the next 10 years or 20 years?’ nobody says ‘yes.’ We’re in this crazy situation. When we made advances with polio or when we discovered antibiotics, we saw those diseases decline and then disappear.

We think we have a great approach to addiction, but addiction never decreases – and we don’t even expect it to. There’s nobody left, either among the public or in the medical arena, to question the whole treatment enterprise, to say, ‘How much worse off would we be if we didn’t have all that research or 12-step groups? Would we really be worse off?’

How Will We Do Better?

“We’ve been approaching addiction and alcoholism as diseases for, really, centuries —even before AA. If you go back to the 19th century and temperance, people believed that alcohol created a degenerative disease where you started drinking mildly and then you ended up in a sanitarium or dead. That’s just the way we think about it. America also believes that we can solve our problems medically. We believe somewhere in a laboratory they’re going to solve addiction medically.

In 50 years, what if alcoholism and addiction rates haven’t gone down? What if they haven’t discovered a cure for addiction in the brain? What if nothing’s changed? What if it’s increased? Will we still be sending people to AA meetings and the Betty Ford Hazelden Center? Will we still be investing hundreds and hundreds of million of dollars into brain research, even if we continue to see addiction and alcohol dependence grow? Can we never get off this track?

If you were to ask me, ‘How are we going to do better with addiction?’ my answer isn’t a very popular one: It’s to reconsider addiction, to reconceive of it – not as being a disease, but instead a life problem, and to find solutions that don’t involve medical technology and research. Let’s say you had a client who had an addiction problem and they didn’t have a job, a stable place to live [or] a family. If you get them to go to a group that meets once a week, like 12 steps, or put them in a hospital and treat them for a month or two and then put them back into the community with all those same problems, the chance that they’re going to succeed is kind of nil.

Instead, you need something that’s practical, longer-lasting and less costly — give them some online material or maybe have them come down for a day and do an assessment and talk about some goals about getting their lives organized, going to school, what kinds of things they need to do to deal with their families, maybe a seminar once a month. In the meantime, you would have call-ins with a helper who would say, ‘How’s that going, getting back together with your wife or your husband? How are you doing about getting your child to go to school? How are you doing about finding an apartment? Well, here’s a way to help you get an apartment.’ When we can help people lead better lives and give them some practical help and allow them to try to get their lives in order better, then we’re going to lower the addiction rate.

It’s as though we are so addicted to the disease theory that we’ve lost track of what we are actually trying to accomplish — which is to create better lives for people so that they have more options to turn to instead of addiction. There is no shortcut in this process, no magic vaccine or inoculation that can remove addiction from a person’s life. And our constant search for such a magic bullet is badly damaging our society.”